Septimiu E. Salcudean

Roozbeh Bazargani, Ladan Fazli, Larry Goldenberg et al.

Graph convolutional neural networks have shown significant potential in natural and histopathology images. However, their use has only been studied in a single magnification or multi-magnification with late fusion. In order to leverage the multi-magnification information and early fusion with graph convolutional networks, we handle different embedding spaces at each magnification by introducing the Multi-Scale Relational Graph Convolutional Network (MS-RGCN) as a multiple instance learning method. We model histopathology image patches and their relation with neighboring patches and patches at other scales (i.e., magnifications) as a graph. To pass the information between different magnification embedding spaces, we define separate message-passing neural networks based on the node and edge type. We experiment on prostate cancer histopathology images to predict the grade groups based on the extracted features from patches. We also compare our MS-RGCN with multiple state-of-the-art methods with evaluations on several source and held-out datasets. Our method outperforms the state-of-the-art on all of the datasets and image types consisting of tissue microarrays, whole-mount slide regions, and whole-slide images. Through an ablation study, we test and show the value of the pertinent design features of the MS-RGCN.

Adam Schmidt, Omid Mohareri, Simon DiMaio et al.

As computer vision algorithms increase in capability, their applications in clinical systems will become more pervasive. These applications include: diagnostics, such as colonoscopy and bronchoscopy; guiding biopsies, minimally invasive interventions, and surgery; automating instrument motion; and providing image guidance using pre-operative scans. Many of these applications depend on the specific visual nature of medical scenes and require designing algorithms to perform in this environment. In this review, we provide an update to the field of camera-based tracking and scene mapping in surgery and diagnostics in medical computer vision. We begin with describing our review process, which results in a final list of 515 papers that we cover. We then give a high-level summary of the state of the art and provide relevant background for those who need tracking and mapping for their clinical applications. After which, we review datasets provided in the field and the clinical needs that motivate their design. Then, we delve into the algorithmic side, and summarize recent developments. This summary should be especially useful for algorithm designers and to those looking to understand the capability of off-the-shelf methods. We maintain focus on algorithms for deformable environments while also reviewing the essential building blocks in rigid tracking and mapping since there is a large amount of crossover in methods. With the field summarized, we discuss the current state of the tracking and mapping methods along with needs for future algorithms, needs for quantification, and the viability of clinical applications. We then provide some research directions and questions. We conclude that new methods need to be designed or combined to support clinical applications in deformable environments, and more focus needs to be put into collecting datasets for training and evaluation.

Adam Schmidt, Omid Mohareri, Simon DiMaio et al.

Quantifying performance of methods for tracking and mapping tissue in endoscopic environments is essential for enabling image guidance and automation of medical interventions and surgery. Datasets developed so far either use rigid environments, visible markers, or require annotators to label salient points in videos after collection. These are respectively: not general, visible to algorithms, or costly and error-prone. We introduce a novel labeling methodology along with a dataset that uses said methodology, Surgical Tattoos in Infrared (STIR). STIR has labels that are persistent but invisible to visible spectrum algorithms. This is done by labelling tissue points with IR-fluorescent dye, indocyanine green (ICG), and then collecting visible light video clips. STIR comprises hundreds of stereo video clips in both in-vivo and ex-vivo scenes with start and end points labelled in the IR spectrum. With over 3,000 labelled points, STIR will help to quantify and enable better analysis of tracking and mapping methods. After introducing STIR, we analyze multiple different frame-based tracking methods on STIR using both 3D and 2D endpoint error and accuracy metrics. STIR is available at https://dx.doi.org/10.21227/w8g4-g548

Ryan Yeung, David Black, Patrick B. Chen et al.

To address the lack of access to ultrasound in remote communities, previous work introduced human teleoperation, a mixed reality and haptics-based tele-ultrasound system. In this approach, a novice takes the role of a cognitive robot controlled remotely by an expert through mixed reality. In this manuscript we summarize new developments to this system and describe a feasibility study assessing its use for long-distance remote abdominal ultrasound examinations. To provide simple but effective haptic feedback, we used an ellipsoid model of the patient with its parameters calibrated using our system's position and force sensors. We tested the system in Skidegate, Haida Gwaii, Canada, with the experts positioned 754 km away in Vancouver, Canada. We performed 11 total scans with 10 novices and 2 sonographers. The sonographers were tasked with acquiring 5 target images in the epigastric region. The image acquisition quality was assessed by 2 radiologists. We collected alignment data and the novices completed task load and usability questionnaires. Both the novices and sonographers provided written and verbal feedback to inform future design iterations. 92% of the acquired images had sufficient quality for interpretation by both radiologists. The mean task load reported by the novices was below reference values reported in literature and the usability was unanimously positive. No correlation was found between image quality and the follower's alignment error with the virtual transducer. Overall, we show that human teleoperation enables sonographers to perform remote abdominal ultrasound imaging with high performance, even across large distances and with novice followers. Future work will compare human teleoperation to conventional, robotic and tele-mentored ultrasound.

Hongzhi Zhu, Robert Rohling, Septimiu Salcudean

Deep learning, especially convolutional neural networks, has triggered accelerated advancements in computer vision, bringing changes into our daily practice. Furthermore, the standardized deep learning modules (also known as backbone networks), i.e., ResNet and EfficientNet, have enabled efficient and rapid development of new computer vision solutions. Yet, deep learning methods still suffer from several drawbacks. One of the most concerning problems is the high memory and computational cost, such that dedicated computing units, typically GPUs, have to be used for training and development. Therefore, in this paper, we propose a quantifiable evaluation method, the convolutional kernel redundancy measure, which is based on perceived image differences, for guiding the network structure simplification. When applying our method to the chest X-ray image classification problem with ResNet, our method can maintain the performance of the network and reduce the number of parameters from over $23$ million to approximately $128$ thousand (reducing $99.46\%$ of the parameters).

David Black, Declan Byrne, Anna Walke et al.

Complete resection of malignant gliomas is hampered by the difficulty in distinguishing tumor cells at the infiltration zone. Fluorescence guidance with 5-ALA assists in reaching this goal. Using hyperspectral imaging, previous work characterized five fluorophores' emission spectra in most human brain tumors. In this paper, the effectiveness of these five spectra was explored for different tumor and tissue classification tasks in 184 patients (891 hyperspectral measurements) harboring low- (n=30) and high-grade gliomas (n=115), non-glial primary brain tumors (n=19), radiation necrosis (n=2), miscellaneous (n=10) and metastases (n=8). Four machine learning models were trained to classify tumor type, grade, glioma margins and IDH mutation. Using random forests and multi-layer perceptrons, the classifiers achieved average test accuracies of 84-87%, 96%, 86%, and 93% respectively. All five fluorophore abundances varied between tumor margin types and tumor grades (p < 0.01). For tissue type, at least four of the five fluorophore abundances were found to be significantly different (p < 0.01) between all classes. These results demonstrate the fluorophores' differing abundances in different tissue classes, as well as the value of the five fluorophores as potential optical biomarkers, opening new opportunities for intraoperative classification systems in fluorescence-guided neurosurgery.

Dan Wang, Xinrui Cui, Septimiu Salcudean et al.

We propose a Transformer-based NeRF (TransNeRF) to learn a generic neural radiance field conditioned on observed-view images for the novel view synthesis task. By contrast, existing MLP-based NeRFs are not able to directly receive observed views with an arbitrary number and require an auxiliary pooling-based operation to fuse source-view information, resulting in the missing of complicated relationships between source views and the target rendering view. Furthermore, current approaches process each 3D point individually and ignore the local consistency of a radiance field scene representation. These limitations potentially can reduce their performance in challenging real-world applications where large differences between source views and a novel rendering view may exist. To address these challenges, our TransNeRF utilizes the attention mechanism to naturally decode deep associations of an arbitrary number of source views into a coordinate-based scene representation. Local consistency of shape and appearance are considered in the ray-cast space and the surrounding-view space within a unified Transformer network. Experiments demonstrate that our TransNeRF, trained on a wide variety of scenes, can achieve better performance in comparison to state-of-the-art image-based neural rendering methods in both scene-agnostic and per-scene finetuning scenarios especially when there is a considerable gap between source views and a rendering view.

Zijian Wu, Adam Schmidt, Peter Kazanzides et al.

The Segment Anything Model (SAM) is a powerful vision foundation model that is revolutionizing the traditional paradigm of segmentation. Despite this, a reliance on prompting each frame and large computational cost limit its usage in robotically assisted surgery. Applications, such as augmented reality guidance, require little user intervention along with efficient inference to be usable clinically. In this study, we address these limitations by adopting lightweight SAM variants to meet the efficiency requirement and employing fine-tuning techniques to enhance their generalization in surgical scenes. Recent advancements in Tracking Any Point (TAP) have shown promising results in both accuracy and efficiency, particularly when points are occluded or leave the field of view. Inspired by this progress, we present a novel framework that combines an online point tracker with a lightweight SAM model that is fine-tuned for surgical instrument segmentation. Sparse points within the region of interest are tracked and used to prompt SAM throughout the video sequence, providing temporal consistency. The quantitative results surpass the state-of-the-art semi-supervised video object segmentation method XMem on the EndoVis 2015 dataset with 84.8 IoU and 91.0 Dice. Our method achieves promising performance that is comparable to XMem and transformer-based fully supervised segmentation methods on ex vivo UCL dVRK and in vivo CholecSeg8k datasets. In addition, the proposed method shows promising zero-shot generalization ability on the label-free STIR dataset. In terms of efficiency, we tested our method on a single GeForce RTX 4060/4090 GPU respectively, achieving an over 25/90 FPS inference speed. Code is available at: https://github.com/wuzijian1997/SIS-PT-SAM

Alexandre Banks, Richard Cook, Septimiu E. Salcudean

Augmented reality (AR) is an effective tool in robotic surgery education as it combines exploratory learning with three-dimensional guidance. However, existing AR systems require expert supervision and do not account for differences in the mentor and mentee robot configurations. To enable novices to train outside the operating room while receiving expert-informed guidance, we present dV-STEAR: an open-source system that plays back task-aligned expert demonstrations without assuming identical setup joint positions between expert and novice. Pose estimation was rigorously quantified, showing a registration error of 3.86 (SD=2.01)mm. In a user study (N=24), dV-STEAR significantly improved novice performance on tasks from the Fundamentals of Laparoscopic Surgery. In a single-handed ring-over-wire task, dV-STEAR increased completion speed (p=0.03) and reduced collision time (p=0.01) compared to dry-lab training alone. During a pick-and-place task, it improved success rates (p=0.004). Across both tasks, participants using dV-STEAR exhibited significantly more balanced hand use and reported lower frustration levels. This work presents a novel educational tool implemented on the da Vinci Research Kit, demonstrates its effectiveness in teaching novices, and builds the foundation for further AR integration into robot-assisted surgery.

Hongzhi Zhu, Robert Rohling, Septimiu Salcudean

Human visual attention has recently shown its distinct capability in boosting machine learning models. However, studies that aim to facilitate medical tasks with human visual attention are still scarce. To support the use of visual attention, this paper describes a novel deep learning model for visual saliency prediction on chest X-ray (CXR) images. To cope with data deficiency, we exploit the multi-task learning method and tackles disease classification on CXR simultaneously. For a more robust training process, we propose a further optimized multi-task learning scheme to better handle model overfitting. Experiments show our proposed deep learning model with our new learning scheme can outperform existing methods dedicated either for saliency prediction or image classification. The code used in this paper is available at https://github.com/hz-zhu/MT-UNet.

Zijian Wu, Adam Schmidt, Randy Moore et al.

Accurate and efficient surgical robotic tool pose estimation is of fundamental significance to downstream applications such as augmented reality (AR) in surgical training and learning-based autonomous manipulation. While significant advancements have been made in pose estimation for humans and animals, it is still a challenge in surgical robotics due to the scarcity of published data. The relatively large absolute error of the da Vinci end effector kinematics and arduous calibration procedure make calibrated kinematics data collection expensive. Driven by this limitation, we collected a dataset, dubbed SurgPose, providing instance-aware semantic keypoints and skeletons for visual surgical tool pose estimation and tracking. By marking keypoints using ultraviolet (UV) reactive paint, which is invisible under white light and fluorescent under UV light, we execute the same trajectory under different lighting conditions to collect raw videos and keypoint annotations, respectively. The SurgPose dataset consists of approximately 120k surgical instrument instances (80k for training and 40k for validation) of 6 categories. Each instrument instance is labeled with 7 semantic keypoints. Since the videos are collected in stereo pairs, the 2D pose can be lifted to 3D based on stereo-matching depth. In addition to releasing the dataset, we test a few baseline approaches to surgical instrument tracking to demonstrate the utility of SurgPose. More details can be found at surgpose.github.io.

Yuxin Chen, Zijian Wu, Adam Schmidt et al.

Purpose: Tissue tracking is critical for downstream tasks in robot-assisted surgery. The Sparse Efficient Neural Depth and Deformation (SENDD) model has previously demonstrated accurate and real-time sparse point tracking, but struggled with occlusion handling. This work extends SENDD to enhance occlusion detection and tracking consistency while maintaining real-time performance. Methods: We use the Segment Anything Model2 (SAM2) to detect and mask occlusions by surgical tools, and we develop and integrate into SENDD an Adaptive Multi-Flow Sparse Tracker (A-MFST) with forward-backward consistency metrics, to enhance occlusion and uncertainty estimation. A-MFST is an unsupervised variant of the Multi-Flow Dense Tracker (MFT). Results: We evaluate our approach on the STIR dataset and demonstrate a significant improvement in tracking accuracy under occlusion, reducing average tracking errors by 12 percent in Mean Endpoint Error (MEE) and showing a 6 percent improvement in the averaged accuracy over thresholds of 4, 8, 16, 32, and 64 pixels. The incorporation of forward-backward consistency further improves the selection of optimal tracking paths, reducing drift and enhancing robustness. Notably, these improvements were achieved without compromising the model's real-time capabilities. Conclusions: Using A-MFST and SAM2, we enhance SENDD's ability to track tissue in real time under instrument and tissue occlusions.

Shuojue Yang, Zijian Wu, Mingxuan Hong et al.

Real2Sim is becoming increasingly important with the rapid development of surgical artificial intelligence (AI) and autonomy. In this work, we propose a novel Real2Sim methodology, Instrument-Splatting, that leverages 3D Gaussian Splatting to provide fully controllable 3D reconstruction of surgical instruments from monocular surgical videos. To maintain both high visual fidelity and manipulability, we introduce a geometry pre-training to bind Gaussian point clouds on part mesh with accurate geometric priors and define a forward kinematics to control the Gaussians as flexible as real instruments. Afterward, to handle unposed videos, we design a novel instrument pose tracking method leveraging semantics-embedded Gaussians to robustly refine per-frame instrument poses and joint states in a render-and-compare manner, which allows our instrument Gaussian to accurately learn textures and reach photorealistic rendering. We validated our method on 2 publicly released surgical videos and 4 videos collected on ex vivo tissues and green screens. Quantitative and qualitative evaluations demonstrate the effectiveness and superiority of the proposed method.

Wanwen Chen, Adam Schmidt, Eitan Prisman et al.

Finding point-level correspondences is a fundamental problem in ultrasound (US), since it can enable US landmark tracking for intraoperative image guidance in different surgeries, including head and neck. Most existing US tracking methods, e.g., those based on optical flow or feature matching, were initially designed for RGB images before being applied to US. Therefore domain shift can impact their performance. Training could be supervised by ground-truth correspondences, but these are expensive to acquire in US. To solve these problems, we propose a self-supervised pixel-level tracking model called PIPsUS. Our model can track an arbitrary number of points in one forward pass and exploits temporal information by considering multiple, instead of just consecutive, frames. We developed a new self-supervised training strategy that utilizes a long-term point-tracking model trained for RGB images as a teacher to guide the model to learn realistic motions and use data augmentation to enforce tracking from US appearance. We evaluate our method on neck and oral US and echocardiography, showing higher point tracking accuracy when compared with fast normalized cross-correlation and tuned optical flow. Code will be available once the paper is accepted.

Zijian Wu, Shuojue Yang, Yueming Jin et al.

In robot-assisted laparoscopic radical prostatectomy (RALP), the location of the instrument tip is important to register the ultrasound frame with the laparoscopic camera frame. A long-standing limitation is that the instrument tip position obtained from the da Vinci API is inaccurate and requires hand-eye calibration. Thus, directly computing the position of the tool tip in the camera frame using the vision-based method becomes an attractive solution. Besides, surgical instrument tip detection is the key component of other tasks, like surgical skill assessment and surgery automation. However, this task is challenging due to the small size of the tool tip and the articulation of the surgical instrument. Surgical instrument segmentation becomes relatively easy due to the emergence of the Segmentation Foundation Model, i.e., Segment Anything. Based on this advancement, we explore the deep learning-based surgical instrument tip detection approach that takes the part-level instrument segmentation mask as input. Comparison experiments with a hand-crafted image-processing approach demonstrate the superiority of the proposed method on simulated and real datasets.

Wanwen Chen, Carson Studders, Jamie J. Y. Kwon et al.

Point cloud registration is important in computer-aided interventions (CAI). While learning-based point cloud registration methods have been developed, their clinical application is hampered by issues of generalizability and explainability. Therefore, classical point cloud registration methods, such as Iterative Closest Point (ICP), are still widely applied in CAI. ICP methods fail to consider that: (1) the points have well-defined semantic meaning, in that each point can be related to a specific anatomical label; (2) the deformation required for registration needs to follow biomechanical energy constraints. In this paper, we present a novel semantic ICP (SemICP) method that handles multiple point labels and uses linear elastic energy regularization. We use semantic labels to improve the robustness of the closest point matching and propose a novel point cloud deformation representation to apply explicit biomechanical energy regularization. Our experiments on a trans-oral robotic surgery ultrasound-computed tomography registration dataset and two public Learn2reg challenge datasets show that our method improves the Hausdorff distance and mean surface distance compared with other point-matching-based registration methods.

Alexandre Banks, Randy Moore, Sayem Nazmuz Zaman et al.

Incorporating an autonomous auxiliary camera into robot-assisted minimally invasive surgery (RAMIS) enhances spatial awareness and eliminates manual viewpoint control. Existing path planning methods for auxiliary cameras track two-dimensional surgical features but do not simultaneously account for camera orientation, workspace constraints, and robot joint limits. This study presents AutoCam: an automatic auxiliary camera placement method to improve visualization in RAMIS. Implemented on the da Vinci Research Kit, the system uses a priority-based, workspace-constrained control algorithm that combines heuristic geometric placement with nonlinear optimization to ensure robust camera tracking. A user study (N=6) demonstrated that the system maintained 99.84% visibility of a salient feature and achieved a pose error of 4.36 $\pm$ 2.11 degrees and 1.95 $\pm$ 5.66 mm. The controller was computationally efficient, with a loop time of 6.8 $\pm$ 12.8 ms. An additional pilot study (N=6), where novices completed a Fundamentals of Laparoscopic Surgery training task, suggests that users can teleoperate just as effectively from AutoCam's viewpoint as from the endoscope's while still benefiting from AutoCam's improved visual coverage of the scene. These results indicate that an auxiliary camera can be autonomously controlled using the da Vinci patient-side manipulators to track a salient feature, laying the groundwork for new multi-camera visualization methods in RAMIS.

Wanwen Chen, Adam Schmidt, Eitan Prisman et al.

Purpose: Intraoperative ultrasound (US) can enhance real-time visualization in transoral robotic surgery. The surgeon creates a mental map with a pre-operative scan. Then, a surgical assistant performs freehand US scanning during the surgery while the surgeon operates at the remote surgical console. Communicating the target scanning plane in the surgeon's mental map is difficult. Automatic image retrieval can help match intraoperative images to preoperative scans, guiding the assistant to adjust the US probe toward the target plane. Methods: We propose a self-supervised contrastive learning approach to match intraoperative US views to a preoperative image database. We introduce a novel contrastive learning strategy that leverages intra-sweep similarity and US probe location to improve feature encoding. Additionally, our model incorporates a flexible threshold to reject unsatisfactory matches. Results: Our method achieves 92.30% retrieval accuracy on simulated data and outperforms state-of-the-art temporal-based contrastive learning approaches. Our ablation study demonstrates that using probe location in the optimization goal improves image representation, suggesting that semantic information can be extracted from probe location. We also present our approach on real patient data to show the feasibility of the proposed US probe localization system despite tissue deformation from tongue retraction. Conclusion: Our contrastive learning method, which utilizes intra-sweep similarity and US probe location, enhances US image representation learning. We also demonstrate the feasibility of using our image retrieval method to provide neck US localization on real patient US after tongue retraction.

Adam Schmidt, Omid Mohareri, Simon DiMaio et al.

Deformable tracking and real-time estimation of 3D tissue motion is essential to enable automation and image guidance applications in robotically assisted surgery. Our model, Sparse Efficient Neural Depth and Deformation (SENDD), extends prior 2D tracking work to estimate flow in 3D space. SENDD introduces novel contributions of learned detection, and sparse per-point depth and 3D flow estimation, all with less than half a million parameters. SENDD does this by using graph neural networks of sparse keypoint matches to estimate both depth and 3D flow anywhere. We quantify and benchmark SENDD on a comprehensively labelled tissue dataset, and compare it to an equivalent 2D flow model. SENDD performs comparably while enabling applications that 2D flow cannot. SENDD can track points and estimate depth at 10fps on an NVIDIA RTX 4000 for 1280 tracked (query) points and its cost scales linearly with an increasing/decreasing number of points. SENDD enables multiple downstream applications that require estimation of 3D motion in stereo endoscopy.

Hongzhi Zhu, Septimiu Salcudean, Robert Rohling

The increased availability and accuracy of eye-gaze tracking technology has sparked attention-related research in psychology, neuroscience, and, more recently, computer vision and artificial intelligence. The attention mechanism in artificial neural networks is known to improve learning tasks. However, no previous research has combined the network attention and human attention. This paper describes a gaze-guided class activation mapping (GG-CAM) method to directly regulate the formation of network attention based on expert radiologists' visual attention for the chest X-ray pathology classification problem, which remains challenging due to the complex and often nuanced differences among images. GG-CAM is a lightweight ($3$ additional trainable parameters for regulating the learning process) and generic extension that can be easily applied to most classification convolutional neural networks (CNN). GG-CAM-modified CNNs do not require human attention as an input when fully trained. Comparative experiments suggest that two standard CNNs with the GG-CAM extension achieve significantly greater classification performance. The median area under the curve (AUC) metrics for ResNet50 increases from $0.721$ to $0.776$. For EfficientNetv2 (s), the median AUC increases from $0.723$ to $0.801$. The GG-CAM also brings better interpretability of the network that facilitates the weakly-supervised pathology localization and analysis.

Golnoosh Samei, Davood Karimi, Claudia Kesch et al.

In this work we propose to segment the prostate on a challenging dataset of trans-rectal ultrasound (TRUS) images using convolutional neural networks (CNNs) and statistical shape models (SSMs). TRUS is commonly used for a number of image-guided interventions on the prostate. Fast and accurate segmentation on the organ in these images is crucial to planning and fusion with other modalities such as magnetic resonance images (MRIs) . However, TRUS has limited soft tissue contrast and signal to noise ratio which makes the task of segmenting the prostate challenging and subject to inter-observer and intra-observer variability. This is especially problematic at the base and apex where the gland boundary is hard to define. In this paper, we aim to tackle this problem by taking advantage of shape priors learnt on an MR dataset which has higher soft tissue contrast allowing the prostate to be contoured more accurately. We use this shape prior in combination with a prostate tissue probability map computed by a CNN for segmentation.

Dan Wang, Xinrui Cui, Xun Chen et al.

Deep CNN-based methods have so far achieved the state of the art results in multi-view 3D object reconstruction. Despite the considerable progress, the two core modules of these methods - multi-view feature extraction and fusion, are usually investigated separately, and the object relations in different views are rarely explored. In this paper, inspired by the recent great success in self-attention-based Transformer models, we reformulate the multi-view 3D reconstruction as a sequence-to-sequence prediction problem and propose a new framework named 3D Volume Transformer (VolT) for such a task. Unlike previous CNN-based methods using a separate design, we unify the feature extraction and view fusion in a single Transformer network. A natural advantage of our design lies in the exploration of view-to-view relationships using self-attention among multiple unordered inputs. On ShapeNet - a large-scale 3D reconstruction benchmark dataset, our method achieves a new state-of-the-art accuracy in multi-view reconstruction with fewer parameters ($70\%$ less) than other CNN-based methods. Experimental results also suggest the strong scaling capability of our method. Our code will be made publicly available.

A. H. Hadi Hosseinabadi, S. E. Salcudean

Instrument-tissue interaction forces in Minimally Invasive Surgery (MIS) provide valuable information that can be used to provide haptic perception, monitor tissue trauma, develop training guidelines, and evaluate the skill level of novice and expert surgeons.Force and tactile sensing is lost in many Robot-Assisted Surgery (RAS) systems. Therefore, many researchers have focused on recovering this information through sensing systems and estimation algorithms. This article provides a comprehensive systematic review of the current force sensing research aimed at RAS and, more generally, keyhole endoscopy, in which instruments enter the body through small incisions. Articles published between January 2011 and May 2020 are considered, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The literature search resulted in 110 papers on different force estimation algorithms and sensing technologies, sensor design specifications, and fabrication techniques.

A. H. Hadi-Hosseinabadi, S. E. Salcudean

This paper presents a novel multi-axis force-sensing approach in robotic minimally invasive surgery with no modification to the surgical instrument. Thus, it is adaptable to different surgical instruments. A novel 6-axis optical force sensor, with local signal conditioning and digital electronics, was mounted onto the proximal shaft of a da Vinci EndoWrist instrument. A new cannula design comprising an inner tube and an outer tube was proposed. The inner tube is attached to the cannula interface to the robot base through a compliant leaf spring with adjustable stiffness. It allows bending of the instrument shaft due to the tip forces. The outer tube mechanically filters out the body forces from affecting the instrument bending behavior. A mathematical model of the sensing principle was developed and used for model-based calibration. A data-driven calibration based on a shallow neural network architecture comprising a single 5-nodes hidden layer and a 5x1 output layer is discussed. Extensive testing was conducted to validate that the sensor can successfully measure the lateral forces and moments and the axial torque applied to the instruments distal end within the desired resolution, accuracy, and range requirements.

Tajwar Abrar Aleef, Ingrid T. Spadinger, Michael D. Peacock et al.

Treatment planning in low-dose-rate prostate brachytherapy (LDR-PB) aims to produce arrangement of implantable radioactive seeds that deliver a minimum prescribed dose to the prostate whilst minimizing toxicity to healthy tissues. There can be multiple seed arrangements that satisfy this dosimetric criterion, not all deemed 'acceptable' for implant from a physician's perspective. This leads to plans that are subjective to the physician's/centre's preference, planning style, and expertise. We propose a method that aims to reduce this variability by training a model to learn from a large pool of successful retrospective LDR-PB data (961 patients) and create consistent plans that mimic the high-quality manual plans. Our model is based on conditional generative adversarial networks that use a novel loss function for penalizing the model on spatial constraints of the seeds. An optional optimizer based on a simulated annealing (SA) algorithm can be used to further fine-tune the plans if necessary (determined by the treating physician). Performance analysis was conducted on 150 test cases demonstrating comparable results to that of the manual prehistorical plans. On average, the clinical target volume covering 100% of the prescribed dose was 98.9% for our method compared to 99.4% for manual plans. Moreover, using our model, the planning time was significantly reduced to an average of 2.5 mins/plan with SA, and less than 3 seconds without SA. Compared to this, manual planning at our centre takes around 20 mins/plan.

Megha Kalia, Tajwar Abrar Aleef, Nassir Navab et al.

Surgical instrument segmentation for robot-assisted surgery is needed for accurate instrument tracking and augmented reality overlays. Therefore, the topic has been the subject of a number of recent papers in the CAI community. Deep learning-based methods have shown state-of-the-art performance for surgical instrument segmentation, but their results depend on labelled data. However, labelled surgical data is of limited availability and is a bottleneck in surgical translation of these methods. In this paper, we demonstrate the limited generalizability of these methods on different datasets, including human robot-assisted surgeries. We then propose a novel joint generation and segmentation strategy to learn a segmentation model with better generalization capability to domains that have no labelled data. The method leverages the availability of labelled data in a different domain. The generator does the domain translation from the labelled domain to the unlabelled domain and simultaneously, the segmentation model learns using the generated data while regularizing the generative model. We compared our method with state-of-the-art methods and showed its generalizability on publicly available datasets and on our own recorded video frames from robot-assisted prostatectomies. Our method shows consistently high mean Dice scores on both labelled and unlabelled domains when data is available only for one of the domains. *M. Kalia and T. Aleef contributed equally to the manuscript

Alaa Eldin Abdelaal, Nancy Hong, Apeksha Avinash et al.

We propose a new method for six-degree-of-freedom (6-DoF) autonomous camera movement for minimally invasive surgery, which, unlike previous methods, takes into account both the position and orientation information from structures in the surgical scene. In addition to locating the camera for a good view of the manipulated object, our autonomous camera takes into account workspace constraints, including the horizon and safety constraints. We developed a simulation environment to test our method on the "wire chaser" surgical training task from validated training curricula in conventional laparoscopy and robot-assisted surgery. Furthermore, we propose, for the first time, the application of the proposed autonomous camera method in video-based surgical skill assessment, an area where videos are typically recorded using fixed cameras. In a study with N=30 human subjects, we show that video examination of the autonomous camera view as it tracks the ring motion over the wire leads to more accurate user error (ring touching the wire) detection than when using a fixed camera view, or camera movement with a fixed orientation. Our preliminary work suggests that there are potential benefits to autonomous camera positioning informed by scene orientation, and this can direct designers of automated endoscopes and surgical robotic systems, especially when using chip-on-tip cameras that can be wristed for 6-DoF motion.

Davood Karimi, Septimiu E. Salcudean

The Hausdorff Distance (HD) is widely used in evaluating medical image segmentation methods. However, existing segmentation methods do not attempt to reduce HD directly. In this paper, we present novel loss functions for training convolutional neural network (CNN)-based segmentation methods with the goal of reducing HD directly. We propose three methods to estimate HD from the segmentation probability map produced by a CNN. One method makes use of the distance transform of the segmentation boundary. Another method is based on applying morphological erosion on the difference between the true and estimated segmentation maps. The third method works by applying circular/spherical convolution kernels of different radii on the segmentation probability maps. Based on these three methods for estimating HD, we suggest three loss functions that can be used for training to reduce HD. We use these loss functions to train CNNs for segmentation of the prostate, liver, and pancreas in ultrasound, magnetic resonance, and computed tomography images and compare the results with commonly-used loss functions. Our results show that the proposed loss functions can lead to approximately 18-45 % reduction in HD without degrading other segmentation performance criteria such as the Dice similarity coefficient. The proposed loss functions can be used for training medical image segmentation methods in order to reduce the large segmentation errors.